![]() In light of this possibility, we review current definitions of TD and recommendations involving thiamine sufficiency and deficiency versus investigated rates of TD. ![]() It is conceivable that they are not and that by presuming sufficiency based solely upon estimated intake compared to RDA values or the absence of frank symptomology and laboratory confirmation, we are missing gradations of disease linked to insufficient thiamine. Insofar as thiamine status is not routinely measured in clinical care and there are no established standards for what constitutes lower or suboptimal thiamine concentrations, or even consensus on what values constitute frank deficiency, it is difficult to ascertain whether the existing recommendations for thiamine sufficiency are adequate to meet the demands of individuals living in modern, industrialized countries. This begs many questions, not the least of which is whether we are conceptualizing nutrient deficiency too rigidly. ![]() Indeed, they are more likely to be overfed, sometimes obese, and to consume sufficient thiamine based on the current RDA values. These individuals are not underfed and they are not likely to consume less than the RDA recommended amount of thiamine. Decades of research data, discussed later in this paper, suggest that it is not and find overt deficiency in large swaths of patient populations not designated as being at risk via familiar parameters. Under these circumstances, TD is considered rare. Symptoms also may be overlooked in countries where fortified foods comprise the majority of calories and thiamine intake is estimated to be above the recommended daily allowance (RDA). In food secure countries, where obesity reigns, it is difficult to consider TD within this context. This is likely due in part to the fact that late 19th and early 20th century descriptions, which still hold sway today, portray the TD as an outcome of starvation-based malnutrition, where emaciation is a common visual. ”Ĭlassically defined thiamine deficiency (TD) disorders in the context of alcoholism and malnutrition are familiar, taught in science and health textbooks from high school onward, and yet, for all of that familiarity, not only are most severe cases of deficiency missed, but the early stages, where symptoms are most easily treated, are entirely disregarded. The more familiar or ‘natural’ they appear, the less we wonder what they mean but because they are widespread and well-known, we tend to act as if we know what we mean when we use them. “There is often something sinister about familiar concepts. Inasmuch as thiamine deficiency syndromes pose great risk of chronic morbidity, and if left untreated, mortality, a more comprehensive understanding thiamine chemistry, relative to energy production, modern living, and disease, may prove useful. This suggests that the RDA requirement may be insufficient to meet the demands of modern living. With an average diet, even a poor one, it is not difficult to meet that daily requirement, and yet, measurable thiamine deficiency has been observed across multiple patient populations with incidence rates ranging from 20% to over 90% depending upon the study. The RDA for thiamine is 1.1–1.2 mg for adult females and males, respectively. It has a very short half-life, limited storage capacity, and is susceptible to degradation and depletion by a number of products that epitomize modern life, including environmental and pharmaceutical chemicals. It is a critical and rate-limiting cofactor to multiple enzymes involved in this process, including those at the entry points and at critical junctures for the glucose, fatty acid, and amino acid pathways. Thiamine or vitamin B1 is an essential, water-soluble vitamin required for mitochondrial energetics-the production of adenosine triphosphate (ATP).
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